Dronedarone in Atrial Fibrillation

Volume 360:668-678 February 12, 2009 Number 7

Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation

Stefan H. Hohnloser, M.D., Harry J.G.M. Crijns, M.D., Martin van Eickels, M.D., Christophe Gaudin, M.D., Richard L. Page, M.D., Christian Torp-Pedersen, M.D., Stuart J. Connolly, M.D., for the ATHENA Investigators Background Dronedarone is a new antiarrhythmic drug that is bein developed for the treatment of patients with atrial fibrillation.
Methods We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were randomly assigned to receive dronedarone, 400 mg twice a day, or placebo. The primary outcome was the first hospitalization due to cardiovascular events or death. Secondary outcomes were death from any cause, death from cardiovascular causes, and hospitalization due tocardiovascular events.

Results The mean follow-up period was 21±5 months, with the study drug discontinued prematurely in 696 of the 2301 patients (30.2%) receiving dronedarone and in 716 of the 2327 patients (30.8%) receiving placebo, mostly because of adverse events. The primary outcome occurred in 734 patients (31.9%) in the dronedarone group and in 917 patients (39.4%) in the placebo group, with a hazard ratio for dronedarone of 0.76 (95% confidence interval [CI], 0.69 to 0.84; P<0 .001=""> (5.0%) in the dronedarone group and 139 (6.0%) in the placebo group (hazard ratio, 0.84; 95% CI, 0.66 to 1.08; P=0.18). There were 63 deaths from cardiovascular causes (2.7%) in the dronedarone group and 90 (3.9%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.03), largely due to a reduction in the rate of death from arrhythmia with dronedarone. The dronedaronegroup had higher rates of bradycardia, QT-interval prolongation, nausea, diarrhea, rash, and an increased serum creatinine level than the placebo group. Rates of thyroid- and pulmonary-related adverse events were not significantly different between the two groups.
Conclusions Dronedarone reduced the incidence of hospitalization due to cardiovascular events or death in patients with atrial fibrillation. (ClinicalTrials.gov number, NCT00174785 [ClinicalTrials.gov] .)

Aspirin May Help Prevent Colorectal Cancer

By Kristina Fiore, Staff Writer, MedPage Today Published: February 11, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

BURLINGTON, Vt., Feb. 11 -- For patients with a history of colorectal adenomas, aspirin may prevent a recurrence, a meta-analysis showed. Patients taking daily aspirin for at least a year had a 17% reduced risk of developing recurrent adenomas, precursors of colorectal cancer (RR 0.83, 95% CI 0.72 to 0.96), Bernard Cole, Ph.D., of the University of Vermont here, and colleagues found in a review of four randomized placebo-controlled trials. This corresponded to an absolute risk reduction of 6.7% (95% CI 3.2% to 10.2%), they reported in the Feb. 18 issue of the Journal of the National Cancer Institute./.../

Driving safety in early Alzheimer

NEUROLOGY 2009;72:521-527
© 2009 American Academy of Neurology 

Predictors of driving safety in early Alzheimer disease

J. D. Dawson, ScD, S. W. Anderson, PhD, E. Y. Uc, MD, E. Dastrup, MS and M. Rizzo, MD

From the Department of Biostatistics (J.D.D., E.D.), Division of Neuroergonomics, Department of Neurology (J.D.D., S.W.A., E.Y.U., E.D., M.R.), Department of Mechanical and Industrial Engineering (M.R.), and Public Policy Center (M.R.), University of Iowa; and VA Medical Center (E.Y.U.), Iowa City, IA.

Address correspondence and reprint requests to Dr. Jeffrey D. Dawson, Department of Biostatistics, University of Iowa College of Public Health, 200 Hawkins Dr., C-22 GH, Iowa City, IA 52242 jeffrey-dawson@uiowa.edu

Objective: To measure the association of cognition, visual perception, and motor function with driving safety in Alzheimer disease (AD).

Methods: Forty drivers with probable early AD (mean Mini-Mental State Examination score 26.5) and 115 elderly drivers without neurologic disease underwent a battery of cognitive, visual, and motor tests, and drove a standardized 35-mile route in urban and rural settings in an instrumented vehicle. A composite cognitive score (COGSTAT) was calculated for each subject based on eight neuropsychological tests. Driving safety errors were noted and classified by a driving expert based on video review.

Results: Drivers with AD committed an average of 42.0 safety errors/drive (SD = 12.8), compared to an average of 33.2 (SD = 12.2) for drivers without AD (p <> errors were lane violations. Increased age was predictive of errors, with a mean of 2.3 more errors per drive observed for each 5-year age increment. After adjustment for age and gender, COGSTAT was a significant predictor of safety errors in subjects with AD, with a 4.1 increase in safety errors observed for a 1 SD decrease in cognitive function. Significant increases in safety errors were also found in subjects with AD with poorer scores on Benton Visual Retention Test, Complex Figure Test-Copy, Trail Making Subtest-A, and the Functional Reach Test.

Conclusion: Drivers with Alzheimer disease (AD) exhibit a range of performance on tests of cognition, vision, and motor skills. Since these tests provide additional predictive value of driving performance beyond diagnosis alone, clinicians may use these tests to help predict whether a patient with AD can safely operate a motor vehicle.

AD = Alzheimer disease; AVLT = Auditory Verbal Learning Test; Blocks = Block Design subtest; BVRT = Benton Visual Retention Test; CFT = Complex Figure Test; CI = confidence interval; COWA = Controlled Oral Word Association; CS = contrast sensitivity; FVA = far visual acuity; JLO = Judgment of Line Orientation; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; NVA = near visual acuity; SFM = structure from motion; TMT = Trail-Making Test; UFOV = Useful Field of View.

Publicar mais, ou melhor?

Publicar mais, ou melhor? O tamanduá olímpico.

Publicado originalmente na:
Revista Brasileira de Ciências do Esporte 29 (1): 35-48, 2007.

ISSN 0101-3289
Luiz Oswaldo Carneiro Rodrigues

Texto encaminhado pela Dra. Maria Inês R. Azambuja

O presente texto discute alguns dos critérios que os órgãos financiadores da pesquisa utilizam para escolher os projetos contemplados nas Ciências do Esporte, embora esta questão possa ser importante também para os cientistas brasileiros de outros campos do conhecimento. Observa-se que as transformações realizadas nos últimos anos nos sistemas de fomento e classificação dos programas de pós-graduação resultaram no aumento da produtividade científica brasileira medida pelas publicações indexadas no contexto internacional. No entanto, a pressão institucional quantitativa pela publicação pode estar induzindo a distorções de comportamento entre os cientistas, o que compromete o próprio sentido do fazer científico e o futuro da ciência no Brasil. Uma comparação entre o tamanduá e a ciência produzida pelos brasileiros pode ser útil no entendimento de algumas propostas de ação para a comunidade científica ligada às Ciências do Esporte.

Prevalence of Left Ventricular Diastolic Dysfunction

 in a General Population

Tatiana Kuznetsova^1,4; Lieven Herbots¹; Begoña López²; Yu Jin¹; Tom Richart³; Lutgarde Thijs¹; Arantxa González²;Marie-Christine Herregods¹; Robert H. Fagard¹; Javier Díez² and Jan A. Staessen³

¹ University of Leuven;
² Center for Applied Medical Research, Pamplona;
³ University of Leuven and University of Maastricht

⁴ E-mail: tatiana.kouznetsova@med.kuleuven.be

Background—Because the process of myocardial remodelling starts before the onset of symp-toms, recent heart failure (HF) guidelines place special emphasis on the detection of subclinical left ventricular (LV) systolic and diastolic dysfunction and the timely identification of risk factors for HF. Our goal was to describe the prevalence and determinants (risk factors) of LV diastolic dysfunction in a general population and to compare the amino terminal-pro-brain natriuretic peptide (NT-proBNP) level across groups with and without diastolic dysfunction.

Methods and Results—In a randomly recruited population sample (n=539; 50.5% women; mean age, 52.5 years), we measured early and late diastolic peak velocities of mitral inflow (E and A), and pulmonary vein (PV) flow by pulsed wave Doppler, and the mitral annular velocities (Ea and Aa) at four sites by Tissue Doppler Imaging. A healthy subsample of 239 subjects (mean age, 43.7 years) provided age-specific cut-off limits for normal E/A, E/Ea ratios, and the differences in duration between the mitral A and the reverse PV flows during atrial systole (Ad – ARd). The number of subjects in diastolic dysfunction groups 1 (impaired relaxation), 2 (elevated LV end-diastolic filling pressure) and 3 (elevated E/Ea and abnormally low E/A) were 53 (9.8%), 76 (14.1%), and 18 (3.4%), respectively. We used (Ad <> pressures in group 2. Compared to subjects with normal diastolic function (n=392, 72.7%), group 1 (209 vs 251 pmol/L; P=0.015) and group 2 (209 vs 275 pmol/L; P=0.0003), but not group 3 (209 vs 224 pmol/L; P=0.65) had a significantly higher adjusted NT-proBNP. Higher age, body mass index, heart rate, systolic blood pressure, serum insulin and creatinine were significantly associated with a higher risk of LV diastolic dysfunction.

Conclusions—The overall prevalence of LV diastolic dysfunction in a random sample of a general population, as estimated from echocardiographic measurements was as high as 27.3%.

200 Years After Darwin

Roger N. Rosenberg, MD; Olaf Stüve, MD, PhD; Todd Eagar, PhD 

JAMA. 2009;301(6):660-662.

On February 12, 2009, we celebrate the 200th anniversary of the birth of Charles Darwin. He has earned the scientific reputation as being the most influential naturalist-biologist of his generation and perhaps of all time. Achievement of his esteemed status resulted initially from studying the geographical distribution of wildlife and fossils collected on his 5-year voyage on the Beagle and concluding that the "transmutation of species" was due to natural selection.¹ In 1858, he was in the process of documenting his research when he received an essay from Alfred Russel Wallace putting forth the same concept of natural selection as the mechanism for generation of new species, resulting in a joint publication that same year.²On the Origin of Species³ was published by Darwin in 1859, making it now the 150th anniversary of its publication. This book proposed evolution as the scientific basis of diversity and species generation produced through the effects of natural selection. Evolution has been proven to be the mechanism for species generation and the engine for change is natural selection, providing the evolved species, beginning from a common organism, adaptation and fitness to maximize reproductionand survival. Dobzhansky put it succinctly by saying that "nothing in biology makes sense except in the light of evolution."⁴Darwin expressed it eloquently in 1859:

There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one;and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endlessforms most beautiful and most wonderful have been, and are being evolved.^3/.../

Science, Politics, and Values

The Politicization of Professional Practice Guidelines

John D. Kraemer, JD, MPH; Lawrence O. Gostin, JD 

JAMA. 2009;301(6):665-667.

The Infectious Diseases Society of America (IDSA) issued updated clinical practice guidelines in 2006 for the diagnosis and treatment of Lyme disease.¹ Within days, the Connecticut attorney general launched an investigation, alleging IDSA had violated state antitrust law by recommending against the use of long-term antibiotics to treat "chronic Lyme disease (CLD)," a label applied by advocates to a variety of nonspecific symptoms for which frequently no evidence suggests the etiologic agent of Lyme disease is responsible. The IDSA was forced to settle the claim to avoid exorbitant litigation costs, even though the society's guidelines were based on sound science. The case exemplifies the politicization of health policy, with elected officials advocating for health policies against the weight of scientific evidence./.../

Susceptibility to Acute Rheumatic Fever

(Circulation. 2009;119:742-753.)
© 2009 American Heart Association, Inc. 

Basic Science for Clinicians

Some of the People, Some of the Time

Penelope A. Bryant; Roy Robins-Browne; Jonathan R. Carapetis; Nigel Curtis

From the Departments of Paediatrics (P.A.B., N.C.), and Microbiology and Immunology (R.R.-B.), University of Melbourne, Parkville, Australia; Infectious Diseases Unit, Department of General Medicine (P.A.B., N.C.), and Infection, Immunity and Environment Theme, Murdoch Children’s Research Institute (P.A.B., R.R.-B., N.C.), Royal Children’s Hospital Melbourne, Parkville, Australia; and Menzies School of Health Research (J.R.C.), Charles Darwin University, Casuarina, Australia.

Correspondence to Professor Nigel Curtis, University Department of Paediatrics, Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia. E-mail nigel.curtis@rch.org.au

Acute rheumatic fever is a major cause of heart disease in large parts of the world, but it remains unknown why only a smallfraction of those who are infected with rheumatogenic group A streptococci develop an abnormal immune response that leads to acute rheumatic fever. An understanding of the mechanisms underlying host susceptibility can provide important insights into pathogenesis that in turn can inform new treatments. Extensive searches for susceptibility factors have been undertaken, including human leukocyte antigens, B-cell alloantigens, and cytokinegenes. Although significant associations have been found between genetic factors and acute rheumatic fever, study results often conflict with each other. This review explores current understanding about host susceptibility to acute rheumatic fever and provides an overall perspective to the number of studies that have recentlyaddressed this subject.

A polêmica de um campeão

Data de Publicação: 06/02/2009

 

Nos últimos dias, acompanhamos o polêmico caso do campeão olímpico de natação Michael Phelps. O atleta americano de 23 anos foi fotografado fumando maconha numa festa, enquanto estava de férias. Mesmo estando longe das piscinas, sua atitude foi punida pela Federação Norte-Americana de Natação com a suspensão de três meses do esporte. Além disso, Phelps perdeu o patrocínio de uma gigante do ramo alimentício, certamente porque a empresa não quer sua marca associada às drogas.

Nestas circunstâncias, surge uma questão: por que um jovem que é recordista olímpico e que se tornou o maior esportista da história em sua modalidade fez uso de uma substância ilícita? É difícil apontar os motivos que levaram Phelps a agir de tal forma. Mas fica claro, mais uma vez, que as drogas não seguem um perfil de usuário. Não escolhem classe social. 

Crianças e adolescentes que praticam algum esporte tendem a admirar e seguir como exemplo o maior atleta da modalidade. Na natação, é Michael Phelps. Neste ponto, sua ação traz pontos negativos. Mas é também verdade que ao perceber o que causou, o nadador tratou de pedir desculpas e disse ter agido de forma pueril e inadequada, passando longe do que as pessoas esperam dele. 

Em contrapartida a tudo isso, não é difícil encontramos artistas, estrangeiros e nacionais, que têm seus nomes associados a marcas de cerveja e cigarros. Ícones da música, da televisão e do cinema que faturam alto apenas por tornarem-se garotos propagandas de empresas que fabricam drogas lícitas. Como se essas substâncias não acarretassem nenhum tipo de mal ao indivíduo que as consome e à sociedade que os abriga. Esquecem-se deste pequeno detalhe que traz desastrosas consequências para todos.

Analice Gigliotti e Sabrina Presman

Human Rights, Health and Development

From: Ruggiero, Mrs. Ana Lucia (WDC)

Daniel Tarantola 1, Andrew Byrnes 2, Michael Johnson 3, Lynn Kemp 4, Anthony Zwi 5, Sofia Gruskin 6

Technical Series Paper # 08.1

THE UNSW INITIATIVE FOR HEALTH AND HUMAN RIGHTS - School of Public Health and Community Medicine

University of New South Wales, Australia

 Available online PDF [26p.] at: http://www.ihhr.unsw.edu.au/images/Publications/2008_IHHR_Technical_Series_Paper_08v1.pdf

 “…..Human rights, health and development represent interdependent sets of values, aspirations and disciplines. Drawing on these domains, this paper offers a theoretical and practical framework for the analysis, application and assessment of health, justice and progress. It provides a simple conceptual framework illustrating the interdependence of these domains and highlights their key features and underlying principles.

 It then describes the reciprocal interactions between health, development and human rights and suggests how these linkages can be analysed and applied in practice. A Health, Development and Human Rights Impact Assessment (HDHR IA) approach is proposed to guide and monitor policies and programs towards maximising synergy….”

 “…This paper explores the links between human rights concerns, improving the health of individuals and communities, and the goals and processes of development that are central to improving people’s living standards and life chances. It builds its analysis around a simple conceptual framework (Figure 1) which illustrates the interdependence of health, development and human rights. It highlights the underlying principles, values and prominent features of human rights, health and development as independent domains, and then describes their interactions. It focuses particular attention on how these linkages can be analysed and reinforced in practice.

This paper also proposes that a Health, Development and Human Rights Impact Assessment (HDHR IA) may be a practical approach that builds on the synergies between the three domains, providing structured and transparent monitoring and evaluation mechanisms to enhance accountability for progress, while revealing shortcomings in policies and programs, and improving human welfare outcomes….”

The Impact Of Smoke-Free Legislation On Coronary Heart Disease

Coronaries And Controversy - 

06 Feb 2009   

A number of studies have been published recently showing a decline in admissions to hospital for heart attack following the implementation of smokefree laws in various countries. Many of these studies, including one on the impact of the Scottish smoking ban [1] have also been the subject of criticism by so-called "dissidents" who claim that the research is nothing more than 'junk' science. In a recently published review [2] ASH's Director of Policy and Research, Martin Dockrell, looks behind the scenes to see what has prompted this criticism and to what extent it is justified. The analysis finds parallels with those who were in denial about the causes of AIDS long after the scientific debate was over. 

The focus of the analysis was a study by Pell and colleagues of the impact of the Scottish smoke-free legislation which found that there was a 17% reduction in hospitalizations for acute coronary syndrome compared with a 4% reduction in England (which had not enacted smokefree legislation). 

The ASH review acknowledges that many of the studies have differing strengths and that no single study can ever demonstrate causation. However, even before the Scottish study was published, the headline figures attracted criticism for being "over-hasty" and constituting "junk science". 

So who was behind the protest and was it justified? Dockrell's review reveals that the strongest critics - Blastland and Dilnot [3] had in fact rejected the research before they had had the opportunity to examine it. Furthermore, ASH believes that all of their criticisms are unfounded and bear close resemblance to the views put forward by tobacco industry proponents. [4] 

Commenting on the dissidents, Martin Dockrell said: 

"While careful analytical critiques of research are welcome, the recent unwarranted attacks on the authors of the smokefree research suggest an ulterior motive. We found an unholy alliance of conspiracy theorists, tobacco industry lobbyists and journalists impatient for a good story." /.../

New Army Suicides Match Civilian Levels

By John Gever, Senior Editor, MedPage Today Published: February 06, 2009

ARLINGTON, Va., Feb. 6 -- The number of suicides among active-duty and reserve Army personnel continues to grow, according to statistics released by the Pentagon.  Last week, the Army announced that 128 soldiers committed suicide in 2008. Both the absolute number and the rate -- 20.2 per 100,000 -- were the highest in decades.  For the first time since the Vietnam War, that rate matched the civilian level, after adjusting for age and sex, the Army's data showed./.../

targeted therapeutics on the rise

Number of targeted therapeutics awaiting FDA approval on the rise

The success of these types of drugs has been noted by pharmaceutical firms who are adding them to their development portfolios.

By Susan J. Landers, AMNews staff. Posted Feb. 9, 2009.

---

Several innovative therapies targeted at the cellular level to treat complex diseases such as cancer are beginning to fill the drug development pipeline.

But they also are likely to remain in the pipeline for a while, given the need for a longer clinical development process dictated by the Food and Drug Administration and by the complexity of the diseases they are intended to treat, according to "Outlook 2009," a report released Jan. 6 by the Tufts Center for the Study of Drug Development at Tufts University in Boston./.../

Drug Companies & Doctors: A Story of Corruption

Volume 56, Number 1 · January 15, 2009 New York Review of Books

By Marcia Angell

Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial

by Alison Bass

Algonquin Books of Chapel Hill, 260 pp., $24.95

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs

by Melody Petersen

Sarah Crichton/Farrar, Straus and Giroux, 432 pp., $26.00

Shyness: How Normal Behavior Became a Sickness

by Christopher Lane

Yale University Press, 263 pp., $27.50; $18.00 (paper)

A Note to Readers

Recently Senator Charles Grassley, ranking Republican on the Senate Finance Committee, has been looking into financial ties between the pharmaceutical industry and the academic physicians who largely determine the market value of prescription drugs. He hasn't had to look very hard.

Income and psychological distress

Income and psychological distress: The role of the social environment

http://www.statcan.gc.ca/pub/82-003-x/2009001/article/10772-eng.htm#1

Authors

Heather M. Orpana (1-613-951-1650; Heather.Orpana@statcan.gc.ca) is with the Health Information and Research Division and Ronald Gravel (1-613-951-2295; Ronald.Gravel@statcan.gc.ca) is with the Health Statistics Division at Statistics Canada, Ottawa, Ontario, K1A 0T6. Louise Lemyre is with the University of Ottawa.

Background

This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years.

Data and methods

Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing high distress, when adjusting for sociodemographic characteristics and baseline health status. It was also used to examine the relationship between reporting a stressor and experiencing a subsequent episode of distress.

Results

Overall, 11% of the initial sample experienced at least one episode of high distress during the 12 years of the study.  Low-income respondents were at a significantly higher risk of becoming psychologically distressed, and many of the stressors were associated with a significantly higher risk of becoming distressed.  Stressors accounted for 22% of the relationship between low income and distress for men, and more than a third of this relationship for women.

Interpretation

Low income is an important risk factor for becoming psychologically distressed, and stressors account for part of this increased risk.

Findings

A large body of research has focused on the poorer physical health of individuals with low income, and important differences in the mental health of these groups can also be observed. Much of this research, however, has been cross-sectional, making it difficult to determine whether low income or poor mental health comes first. As well, few studies have looked at this relationship in the Canadian context. [Full text]

Bisphenol A Mimics Estrogen, Phthalates Target Testosterone

By Kristina Fiore, Staff Writer, MedPage Today Published: February 05, 2009

NEW YORK, Feb. 5 -- Call these chemicals "his" and "her" endocrine disruptors. Although they have been linked to reproductive problems in both sexes, bisphenol A (BPA) and phthalates -- common chemicals found in household plastics -- have gender-specific effects. BPA mimics estrogen, while phthalates block testosterone action, Hugh S. Taylor, M.D., of Yale University, said at a press briefing. "BPA looks like estrogen," Dr. Taylor, whose research focuses on uterine development and endocrine disruption, said of its chemical structure. "By itself it is a very weak estrogen." The chemical stimulates uterine growth, he said, and animal studies have revealed other estrogen-like effects./.../

Davos 2009

• 5 of 5
• 

The Great Fall

By MICHAEL ELLIOTT AND PETER GUMBEL / DAVOS

ILLUSTRATION FOR TIME BY DENNIS WONG

(3 of 4)

Should such national bank-rescue schemes be subject to international control, and if so, by whom? At one limit, Angela Merkel, the German Chancellor, has advocated a sort of United Nations Economic Council, much like the Security Council. The idea has as yet won few backers — and the long, unsuccessful attempt to reform the membership of the Security Council itself would suggest it will get nowhere. Brown and others have urged reform and recapitalization of the Bretton Woods international financial institutions (IFIs), with a much greater role handed to the International Monetary Fund, to which Japan, quietly re-establishing the credibility in international financial debates it had in the 1980s, has pledged $100 billion. But reform of the IFIs, especially to give more weight to the views of developing economies (a key theme of Davos, with the chorus led by South Africa's finance minister Trevor Manuel) has been on the international agenda for the better part of two decades, to little evident effect. And then there is this week's issue: should the pay of bankers whose firms are being bailed out be limited, as the Obama Administration in the U.S. has said it plans to do?

Hepatology 2009 is available for download (PDF, 9MB)

Sebastian.Kamps@amedeo.com

Dear Colleague,

Mauss et al. have just published

Hepatology 2009
A clinical textbook
501 pages
ISBN: 978-3-924774-63-9

Hepatology 2009 is available for download (PDF, 9MB) at
http://www.hepatologytextbook.com/download12.htm

Hepatology 2009 is the winner of the second Amedeo Challenge Award (http://www.AmedeoChallenge.org). The textbook includes chapters on Hepatitis (A-E), Coinfections, Liver Fibrosis, Hepatocellular Carcinoma, Liver Transplantation, and Autoimmune and Metabolic Liver Diseases.

The editors and the authors agree to remove the copyright on their book for all languages except English and German (see http://www.HepatologyTextbook.com/ht/cr.htm).


Please inform your students and colleagues.

Best regards,
Bernd Sebastian Kamps

___________________________________________
Bernd Sebastian Kamps, M.D.
Flying Publisher
Amedeo
www.bsk1.com

health and human rights

From: Ruggiero, Mrs. Ana Lucia (WDC)

Pan American Health Organization PAHO/WHO 2009

Website: http://new.paho.org/hq/index.php?option=com_content&task=view&id=549&Itemid=643

 

PAHO/WHO’s strategies on health and human rights have as an objective the dissemination and promotion of the international human rights norms and standards among community leaders, health service users, advocacy group members, ombudspersons, medical professionals, and government workers and decision-makers, among others

Reducing health inequities through action on the social determinants of health

From: Ruggiero, Mrs. Ana Lucia (WDC)

WHO 124th Session EB124.R6 - Agenda item 4.6 -  23 January 2009

 WHO  Executive Board, Having considered the Secretariat’s report on the final report of the Commission on Social Determinants of Health,1 

RECOMMENDS to the Sixty-second World Health Assembly the adoption of the following resolution:

 Spanish: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-sp.pdf 

English: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-en.pdf

 

            French: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-fr.pdf

 “………Confirming the importance of addressing the wider determinants of health and considering the actions and recommendations set out in the series of international health promotion conferences, from the Ottawa Charter on Health Promotion to the Bangkok Charter for Health Promotion in a Globalized World making the promotion of health central to the global development agenda as a core responsibility of all governments (resolution WHA60.24);

“……..URGES Member States:

(1) to develop and implement goals and strategies to improve public health with a focus on health inequities;

(2) to take into account health equity in all national policies that address social determinants of health and to ensure equitable access to health promotion, disease prevention and health care;

(3) to ensure dialogue and cooperation among relevant sectors with the aim of integrating a consideration of health into relevant public policies;

(4) to increase awareness among public and private health providers on how to take account of social determinants when delivering care to their patients;

(5) to contribute to the improvement of the daily living conditions contributing to health and social well-being across the lifespan by involving all relevant partners, including civil society and the private sector;

(6) to contribute to the empowerment of individuals and groups, especially those who are marginalized, and take steps to improve the societal conditions that affect their health;

(7) to generate new, or make use of existing, methods and evidence, tailored to national contexts in order to address the social determinants and social gradients of health and health inequities;

(8) to develop, make use of, and if necessary, improve health information systems in order to monitor and measure the health of national populations, with data disaggregated according to the major social determinants in each context (such as age, gender, ethnicity, education, employment and socioeconomic status) so that health inequities can be detected and the impact of policies monitored in order to devise appropriate policy interventions to minimize health inequities  ……..”

 Eugenio Villar, Coordinator 

Department of Ethics, Equity, Trade and Human Rights (ETH) 
Information Evidence and Research (IER) World Health Organization 

Chronic Disease Cost Calculator

From: Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion 

Chronic diseases – such as heart disease, stroke, cancer, and diabetes – are among the most prevalent, costly, and preventable of all health problems. Medicaid spending has grown rapidly in recent years and is placing a significant burden on state budgets. It has become increasingly important to help states quantify and understand the financial impact caused by chronic diseases, as well as to inform state decisions on investments in chronic disease prevention and disease management programs.

To help states estimate the burden and financial impact of chronic diseases among their Medicaid beneficiaries, the Centers for Disease Control and Prevention and RTI International, in partnership with the Agency for Healthcare Research and Quality, the National Association of Chronic Disease Directors, and the National Pharmaceutical Council, developed the Chronic Disease Cost Calculator.

The Chronic Disease Cost Calculator is a downloadable tool that supports states in:

(1) Estimating state Medicaid expenditures for six chronic diseases – congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes.

(2) Generating estimates of the costs to Medicaid of selected chronic diseases using customized inputs (e.g., prevalence rates and treatment costs).

It is important to note that the Cost Calculator does not provide exact prevalence and Medicaid costs of the chronic diseases for each state. All reported numbers are estimates and could differ from actual values. The uncertainty in the estimates arises from a number of factors: the combination of several data sources, different levels of geographic detail available in the source data, and the fact that the parameters of the statistical analysis are themselves estimates. Due to differences in data sources and methods, the estimates will not necessarily agree with other cost estimates. When discrepancies occur between Cost Calculator estimates and other state Medicaid estimates, users should contact their state Medicaid department and state health department for clarification.

For a detailed explanation of Cost Calculator methodology, including how it calculates prevalence and per person costs, refer to the Chronic Disease Cost Calculator Technical Appendix (PDF–740K). For a detailed explanation of how to use the Cost Calculator, refer to the Chronic Disease Cost Calculator User Guide (PDF–781K).

Links:

• Download the Chronic Disease Cost Calculator
• Chronic Disease Cost Calculator Resources
• Chronic Disease Cost Calculator Top FAQ
• Help, technical questions or comments

FOR SOME, LDL CHECK DOES NOT PREDICT HEART’S FUTURE

By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  January 21, 2009--New evidence shows that some people can be at increased risk for heart trouble even when their “bad” LDL cholesterol is at what’s considered a healthy level.

In an analysis from the INTERHEART study----a large-scale, case-control study looking at the relationship between blood fats and first heart attack in Asians---an international team of researchers found that even though LDL levels were on average 10 points lower in Asians than non Asians, heart attack risk was similar.

This scientific research, involving more than 12,000 people, is the first to compare data on ethnic groups across Asia---including South Asians, Southeast Asians, Chinese, and Japanese---as well as non Asians.  Researchers found that a greater proportion of Asians have LDL levels below 100 compared to non Asians, yet still have a high rate of heart attack. 

In recent years doctors have realized that some versions of “bad” cholesterol and other fats are worse than others. And they reason that two protein checks, apolipoprotein A (Apo A-1) and apolipoprotein B (Apo B), may be just as---if not more---important as your cholesterol reading in predicting heart risk.

Apo A-1 is a protein that ushers artery-clogging fats out of the bloodstream, while Apo B delivers those potentially damaging substances to vessel walls and leaves them behind. HDL cholesterol (the “good” kind) carries Apo A-1 protein.  LDL cholesterol and several other “bad” fats carry the Apo B protein type.  So having a high concentration of Apo B containing particles predisposes to artery wall damage and plaque build up.

In this study, abnormal protein levels---a low apolipoprotein A (apo A-1) and a high apoliprotein B (Apo B)---emerged as the strongest warning signaling risk of first heart attack.

The implication of this study is that LDL and HDL may not be the best targets in regard to therapy for reducing cardiovascular events, says study co-author Salim Yusuf, DPhil, professor of medicine at McMaster University in Ontario, Canada. “Apo A-I and Apo B are better markers. We were looking at the wrong component of lipids in assessing risk.”

Editors Comment:  Apo A-1 and Apo B levels are tests which are not routinely performed in clinical practice today.  However, data continues to mount with respect to the utility of these measurements, and it is very possible that apolipoprotein monitoring will replace traditional cholesterol evaluations in the future.  Some laboratories do offer this analysis and patients should check with their physicians to see if they are good candidates for this type of testing.  Because the absolute cholesterol values which placed Asian patients at higher risk for heart attack were relatively low in this large study, goal cholesterol levels and thresholds for initiating cholesterol lowering therapy may need to be adjusted for this population.

This study was published in the January 27, 2009 issue of the Journal of the American College of Cardiology. 

SOURCES:

Karthikeyan G. et al. Lipif Profile, Plasma Apoliproteins, and Risk of a First Myocardial Infarction Among Asians: An Analysis from the INTERHEART Study. The Journal of the American College of Cardiology, 2008.

 Salim Yusuf, DPhil, Professor of Medicine, McMaster University, Hamilton, Ontario, Canada.

Depression in later life in primary care

Published 2 February 2009, doi:10.1136/bmj.a3079
Cite this as: BMJ 2009;338:a3079

Research

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

E Licht-Strunk, general practitioner and postdoctoral fellow¹, H W J Van Marwijk, general practitioner and associate professor of general practice¹, T Hoekstra, PhD student², J W R Twisk, professor of methodology and applied biostatistics³, M De Haan, general practitioner and professor of general practice¹, A T F Beekman, psychiatrist and professor of psychiatry⁴

¹ Department of General Practice and the EMGO Institute for Health and Care Research of VU University Medical Centre, Van der Boechorstraat 7, 1081 BT, Amsterdam, Netherlands, ² Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Netherlands, ³ Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, ⁴ Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Centre

Correspondence to: E Licht-Strunk e.licht@vumc.nl

Abstract

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (55 years) in primary care.

Design Longitudinal cohort study, with three years’ follow-up.

Setting 32 general practices in West Friesland, the Netherlands.

Participants 234 patients aged 55 years or more with a prevalent major depressive disorder.

Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariableanalyses were used to identify variables predicting prognosis.

Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but notin those who had recovered.

Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.